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FOR OFFICE USE: ;s r--APPLICATION FOR SANITATION PERMIT FOR OFFICE USE; ... .. ...........". � (Complete in Triplicate) .....rl��... ..---•-----•--•--•- Permit No ... . .".. --------------- Date Issued-3.2-.26•�--'�--�- '----- - This Permit Expires 1 Year From Date Issued ,Application is hereby made totheSan Joa uin Localrmit ' This application is made in compliance wi h County Ordinance and existing Rulers andnReg stall the work herein described. JOB ADDRESS/LOCATION--- _ _ 2,_5 Y ' ..-_.. ".._.....1.�J - fir --- . . i CEN U I oP .. Owner's Name-. N ..-_..�.--- .................• Ph Address...../.s.3 ... . . . 4 - Ci .rC .-.--......- Contractor's Name. "..- �I Zip... •-------...- �. ------- License # ---------..Phone--------- ---------••---------•---- � l_nstallation will serve; Residence 'i�.._--�•.----- .-- .- .�. . -- ❑ Apartment House ❑ Commercial ❑ Trailer Court ®/ Motel [�,: Other:..:.. ......................... Numbevof living units---- -----------Number of bedrooms. _. i .� Garbage Grinder-- --.__,:.Lot Size..-------------- Public Supply: Public System and name---------------- ------------ ....-".. S '� -------------------............................• - . -•---Private �-- Character of soil to a depth of 3 feet: Sand 0 lit❑ Clay ❑ Peat Cl SandyrLoam ❑ Clay Loam Q� P ❑ Adobe ❑ ,!Fill Material if yes, type---------- -------- (Plot plan, showing size of lot, location of system iri.relation to wells, buildings, etc. must be placed on reverse side. NEW .INSTALLATION: ir ) U (No septic tank or seeps' pit permitted if public sewer is-Available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANKSize... c j ype-' •--------- ------- ----Liquid Depth,::::--------------- Capacity-,l�-�U-- T �•- - -- .. --- .s. --- --- ------Materialt�rlrP��;:-•-._No. Compartments.-----�,_---_-•--- LEACHING stance to nearest..Well_',,,l p...................... ...'Foundatiori...�f,`. ..- Prdp. Line - _ -". `... G LINE j NDo.BOXLines.. a Filter Materia of each line.--.,$ _` �-..--t-----•----;- Tatal Length -. ."4-`Y'�-F----= ----�------ ' t Py I .. - YP - -.--_.De th Filter Material-------- Distance to nearest: Well_'/AQ-----------------Foundation.-.1 SEEPAGE PIT ' Depth - ..:.-_-..-... ......Property Line_ ----- .......... - er � Number.".------ ---------------------- Rock Filed.. 'Yes ❑ No❑ Water Table Depth............ �! Rack S ize Distance to nearest: Well---- - -------------------- ...... ........foundation ..--- ~s. . .-:- .:_.Prop. Line:,x• ---- -- _ ____ REPAIR/ADDITION {Prev. Sanitation Permit#------------='-- Date ............. e. Septic Tank (Specify Requirements)_.. -------------------------- ------------------- ----------- ...... ................... ---------- ----isposal Field (Specify Requirements)---- ------- --- -!..-..::_.-------. 4 ------------- •----.... ••-------- ------ ___ {Draw existing"and required addition on reverse side) I =Certify that I have prepared this application and that the work will be done in accordance with^ San Joaquin County Oes, State_ Laws, and Rules and Regulations of the San Joaquin Local Health-District, signature certifies the following:: Home owner or licensed agents � "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's tom ati on f California," Signed � �/ �/� Owner By=------------ --- - - _. I Title E' 3. ................ ..........""--- � (If other than owner) ":--- ' FOR DEPARTMENT USE ONLY APPLICATION Ar r•Farcn BY r/ - DATE...DIVISION DlVISlON O.F LAND NUMBER ...- ADDLTlONAL COMMENTS_, PJf ff/ DA _ ............ ------ - Final Inspection b y:. f 1 i x I EH 13 24 SAN JOAQUIN LOCAL HFt 1 TH DISTRICT Fss aian Rfv ripe sM